Developing proton therapy · 2018-11-19 · CAX plot: 0 20 40 60 80 100 120 140 0 5 10 15 20 25 30...

The Christie NHS Foundation Trust

Developing proton therapy

Dr R I MacKay



Testing underway for UK proton beam cancer treatment

Advanced Oncotherapy has begun testing its groundbreaking Light machine for the

UK’s first proton beam therapy centre, in what is expected to be a cancer treatment

milestone when it opens by the end of next year.

The Telegraph - Comment on this story

Will the UK become the proton therapy centre of Europe?

Several companies are opening proton beam therapy centres across the UK as the

treatment becomes more popular. Recent independent medical research suggests that

proton beam cancer therapy treatment is far less harmful and traumatic to cancer

patients than chemotherapy. Proton Partners International will bring the world’s first

digital PET CT system to Wales. The equipment fitted at the UK’s first proton beam

therapy centre will provide cancer patients with the most advanced cancer technology

available.

Radiotherapy News

http://actionradiotherapy.us7.list-manage2.com/track/click?u=2d0e20f43a97904394ffb9d85&id=f0e1c2c97c&e=2c850ee959

http://actionradiotherapy.us7.list-manage2.com/track/click?u=2d0e20f43a97904394ffb9d85&id=77bb91fca2&e=2c850ee959


Radiotherapy

• After surgery, it is the next most important method of

curing cancer.

• 40% of all patients cured of cancer are cured by

radiotherapy.

• 50% of all cancer patients will benefit from receiving

radiotherapy as part of their cancer management.

• Its use is continuing to expand. This is due to better

patient pathways, the role of multi-disciplinary team

meetings and more integrated treatments.


A little history…

Very quickly after Roentgen’s discovery of

X-rays and Marie Curie’s discovery of

radioactivity, they were both being used to

treat disease, including cancer

Freund/Schiff 1896 – skin treatments

Emil Grubbe 1897 – cancer treatment

Herbert Jackson 1896 – use of electron

focusing


A smorgasbord of radiotherapy

Brachytherapy:

X, g, b

Ir-192, Co-60, Cs-137,

Au-198

I-125, Ra-226

Teletherapy

g

Co-60, Cs-137

X-ray

radiotherapy

X

6-40 MeV

electrons onto W

target

Particle therapy

p, C, etc.

Cyclotrons,

synchrotrons etc.


Radiotherapy Linear Accelerator

• Electron

• Standing or travelling wave

• 4- 20 MV but most commonly 6 -10MV

• Dose rate for photons ~ 5Gy a minute

• Field size 30x40cm – 5mm MLC

• Electrons impact on a tungsten transmission

target to produce x-ray beam

• Beam flattened and shaped


External Beam Radiotherapy


Prostate

The Christie NHS Foundation Trust9

Single beam isodose plot


Parallel opposed pair


Parallel opposed pairReduced the area of high dose

Still treating a large volume of normal tissue (in particular the rectum in this case)

CAX plot:

0

20

40

60

80

100

120

140

0 5 10 15 20 25 30

Distance(cm)

Do

se (

Arb

)

ANT

POST

Combined


Four field brick


Radiotherapy Development Timeline

1990 2000 2010MLC

IMRT

IGRT

VMAT

MR Linac

Proton therapy

The Christie Advanced Radiotherapy

Summer School (11th - 14th July 2016) The Christie, Manchester, UK, M20 4BX

Further info: http//adv-radiotherapy.eventbrite.co.uk


X-ray - Proton Therapy

X-ray Proton


Superior dose distribution

Photon (x-ray) treatment Proton treatment

Benefits of protons




NHS Proton Overseas Programme

Approved Treated

Paediatric 483 429

Adult 197 145

Total 680 574

Total

Referred

861

• Structured Approach

• Curative Intent

• Clinical Policies and Defined Criteria

• All Cases Reviewed by National Panel

• Equity of Access

• 2 Centres USA,

• Jacksonville and Oklahoma

• PSI Villigen

• Outcomes Tracking

• High patient satisfaction

Growth in Approvals

since 2008

0

20

40

60

80

100

120

140

160

180

200

2008 2009 2010 2011 2012 2013 2014

A P


Capacity - Patient Groups

• 1% all RT Capacity

• NHS England Service Review Radiotherapy

• Business as usual

• Highly Specialised Commissioning

• Clinical Trials• Breast

• Lymphoma

• Brain and Spinal Cord

• Evaluative Commissioning (CtE)

• ‘Enhanced Commissioning Research’

Categories 1500

Paediatric 278

TYA 185

Adult Core 314

Devolved

Administrations

147

Total 924

Remaining

Capacity

576


Country Population Rooms % of all RT

Sweden 9.5M 2 14%

Denmark 5.6M 3 7%

Holland 17M 7 10%

Norway 5.1M 6

England 56M 6 1%



Beam Parameters

• Beam energy ~ 60- 240MeV

• Spot size at max beam energy in

air ~ 3.5mm

• Dose rate 2Gy to one litre in 1min

• Field size 30x40cm



1st scanner

magnet Y

2nd scanner

magnet X

vacuum

drift tube

dose and

position monitor

2560 mm

2000 mm

895 mm


Scanning Beams


PBS IMRT


NHSe commissioned provision

Care within a wider NHS setting

• Mostly rare tumours/inidications

• Complex pathway management

• Comprehensive outcomes analysis

• Core and evaluative indications

• Established research environment

Care within established Cancer Centres

• Protons - 3 Gantries, 360o

• Advanced photon capacity

• Comprehensive support services

• Paediatric/TYA/Adult

• Acute care

• Diagnostics

• Chemotherapy

• Patient Support

• Academic/Research environment

• Accommodation


Key issues

• Complexity

– It shall deliver proton

radiotherapy for the prescribed

Indication List

– Complex indication list with high

proportion of paediatrics

Dose

– Improved dose distributions

compared to photon

radiotherapy

Throughput

– It shall deliver the improved

dose distribution to as many

patients as possible

Value for

money


2012 2020

2013 2014 2015 2016 2017 2018 2019 2020

DH approval

Site works

commence

HM Treasury/

Monitor approval

HM Treasury

OJEU issued

BoD OBC Christie FBC

Equipment

delivery First patient Full capacity

3 rooms

Projected proton therapy programme

Indicative timeline





Summarise

• Radiotherapy is an effective treatment of cancer and has

advanced considerably over the last 20 years

• Proton therapy is one development of radiotherapy that

improves dose distribution and enhances outcome for

patients

• The national facilities at the Christie and UCLH UK will

offer a limited provision for patients that currently have to

go abroad for treatment

• Research into the technology and benefits of proton

therapy is an important part of proton therapy

developments in the UK

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Developing proton therapy · 2018-11-19 · CAX plot: 0 20 40 60 80 100 120 140 0 5 10 15 20 25 30...

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